Scaling up with other HIV interventions and services
Q.32 How can breastfeeding and ARVs be recommended in remote clinics when ARVs to prevent postnatal HIV transmission may not be available?
Every effort should be made to ensure that ARVs reach all facilities and not just those in urban or more affluent parts of a country or region. The supply chain for all other essential medicines should be used to ensure that ARVs for HIV-infected mothers are consistently available.
The alternatives to breastfeeding with ARVs are either that mothers avoid all breastfeeding (and presumably provide replacement feeds), or breastfeed without ARV prophylaxis. Mothers attending remote clinics are less likely to have good access to safe water and sanitation. In these settings, formula feeding would be unsafe and impractical. For this reason, even without ARVs, breastfeeding may still lead to the best outcome in terms of HIV-free survival for HIV-exposed infants (see also Q.17).
Health authorities should make efforts to ensure that ARVs are available to all HIV-infected mothers who need them, no matter where they live and go for health services.